Transversus Abdominus and Its Role in Lumbar Spinal Stabilization

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Transversus Abdominus and Its Role in Lumbar Spinal Stabilization

Transversus Abdominus and its Role in Lumbar Spinal Stabilization 

Spinal stability is dependent upon three sub-systems: the active or contractile system, the passive or non-contractile system and the neural control system. (Panjabi, 1992). If dysfunction is present in any one or a combination of these sub-systems, the stabilizing capacity of the spine will be compromised and painful movement more likely to occur. While all muscles contribute to spinal stability and movement, some are better suited than others to provide dynamic stability. In the lumbar spine (L/S), the deeper muscles, close to the axis of joint motion, with a predominance of Type I muscle fibers, have proven more effective as stabilizers than the larger, more superficially located lumbar spinal muscles.

Research has shown that: 1) people with low back pain (LBP) present with atrophy and altered activation of the deep spinal muscles when compared with persons without LBP (Hodges et al., 1996; Hides et al., 1994) and 2) the deep spinal muscles play a key role in developing inter-segmental motion stiffness which translates into improved dynamic control of the spine (Hodges et al., 2003).

Transversus Abdominus (TA) is an important dynamic stabilizer of the L/S. TA is able to directly increase intra-abdominal pressure which converts the trunk into a more solid cylinder. This reduces compression and shear forces acting on the L/S and transmits them over a wider area (Twomey & Taylor, 1987). TAs attachment to the thoracolumbar fascia further increases its ability to stabilize the L/S.

The success of specific spinal stabilization training for TA and other deep muscles lies in: 1) teaching clients to activate the dysfunctional muscle in isolation of other muscles; 2) effectively retraining slow twitch muscle fiber function through isometric contractions (low loads, sustained hold times); 3) repetition: to aid motor reprogramming; 4) teaching co-contraction of the target muscle, first with other deep muscles, then the global muscle network and 5) training carryover for physical and functional tasks of increasing levels of difficulty.

“Exercises that target the deep abdominal muscles with minimal external loading in the spine have been shown to be effective in increasing lumbar stability, thus treating and preventing the recurrence of LBP.” (Teyhen et al., 2008; Axler & McGill, 1997).

The physiotherapists at Corona Station Physical Therapy recognize the importance of specific exercise prescription and a properly executed home exercise program to ensure optimal rehabilitation results. Time is spent educating the client as to the importance of the exercises they are given, while frequent review ensures proper exercise technique and allows for appropriate progressions. We believe it pays to be picky! For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Gluteus Medius Weakness

Gluteus Medius Weakness

The Gluteus Medius

The gluteus medius is one of three gluteus muscles that originates on the posterior aspect of the pelvis and inserts into the lateral femur. It is know to abduct the hip and internally or externally rotate the femur depending on the position of the leg (1). More recently it has been shown to be an important muscle for stabilization, keeping the pelvis level and preventing internal rotation of the hip and the knee from buckling inward during weight-bearing.

This role as a muscle of stabilization has some important implications for injury prevention. Gluteus medius weakness has been linked to low back pain, patellofemoral pain syndrome, achilles tendonopathy and IT band syndrome(2,3). If a muscle of stabilization is weak or dysfunctional, it can lead to compensation from other muscles in the chain, leading to overuse injuries such as tendonitis.

A physical therapist can assess for gluteus medius weakness a number of ways, including testing the strength of abduction in side lying, testing internal rotation in sitting, or looking for a drop of the pelvis or Trandelenburg sign when an individual is standing on one leg. Once weakness in the muscle has been identified, the physical therapist can develop a specific exercise program to address the problem and prevent or rehabilitate an injury. Exercises may start with abduction or internal rotation in sitting or lying and progress to more functional activities in weight-bearing, including the activation of gluteus medius in combination with other muscles of the lower extremity as is typical of higher level activity such as sports.

For more information, please contact the clinic to speak with one of our experienced physical therapists.

References

1) Delp SLHess WEHungerford DSJones LCVariation of rotation moment arms with hip flexionJournal of Biomechanics 32 (1999) 493—501

2) Cooper NA1, Scavo KMStrickland KJTipayamongkol NNicholson JDBewyer DCSluka KAPrevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controlsEur Spine J 2015 May 26

3) Fredericson, M, Cookingham CLChaudhari AMDowdell BCOestreicher NSahrmann SAHip abductor weakness in distance runners with iliotibial band syndromeClinical Journal Sport Med. 2000 Jul;10(3):169-75